Response and critique

Abstract

This paper is being published when there is concerned discussion about the relationship of psychiatry to the community mental health movement. The number of psychiatrists in CMHCs has dropped considerably. Some would say that the CMHCs are pushing psychiatrists out while others would point the finger in the opposite direction, suggesting that psychiatrists are abandoning the CMHCs. In any case, the matter is important enough for the American Psychiatric Association and the National Council of Community Mental Health Centers to be planning a national meeting on the topic. If psychiatrists continue to diminish in numbers in CMHCs or if they are only to be part-time prescription signers, there is little point in trying to train more of them for such careers. If they are to have more significant involvement, it is essential to explore the relationships between academic programs and CMHCs. The concerns on each side reflect more than suspicion by the CMHCs that the academic programs will rip them off and by the academic chairmen that the resident will be used for service instead of being educated. The problems reflect the current criticisms of the CMHCs, namely that they have changed from the original health services model to a social activist model, that they have adopted anti-medical attitudes relegating psychiatrists to signing prescriptions or insurance forms, and that they have given undue emphasis to unproven prevention programs while neglecting the seriously mentally ill. Such criticisms are of intense concern to those of us who early identified the CMHC as the basic delivery system for the public sector and who have advocated a model of community mental health as developed in the mid 1960's. To have a successful relationship between an academic program and a CMHC there must be an underlying assumption that the CMHC movement will continue (hopefully more like the original than the present model) and that it will involve psychiatrists in appropriate numbers and professionally meaningful roles. If so, all psychiatrists ought to get a significant clinical experience in such a center. The issue is not one of "control"--academic departments have long been placing students in clinical settings which they don't control. A basic issue in the relationship is that the CMHC must recognize that the reason for a student being assigned to any clinical setting is to learn--not just to give service. Whether the